Membership Renewal
For Joint Membership or Family Membership each person must complete this form. STUDENTS - If current NTU or UON fill in Student membership form www.eastmidlandsregionalrange.org.uk/join-the-club
Membership Number
If you know it
Full Name
*
First Name
Last Name
Name you use / known by
Date of Birth
-
Month
-
Day
Year
Address
*
Street Address
Street Address Line 2
City
County
Post Code
Phone Number
Format: 00000 000 000.
E-mail
*
example@example.com
Medical information
Assistance required / Medication / Emergency information
Emergency Contact
Name
Address
City
Post code
Note
Emergency Contact Phone Number:
Do you have a FAC / SGC (if yes please give details)
Make / Model / Serial Number
What firarms do you currently own?
Make / Model / Serial Number
Are you / Have you been a member of another club or shooting organisation?
Make / Model / Serial Number
I am not prohibited under Section 21 of the Firearms Act 1968, or otherwise, from holding or possessing any firearm or ammunition
*
Tick to confirm statement
I Agree to EMRR GDPR policy (available on request)
*
Tick to confirm
Please provide a passport style photo for your membership card - Take Photo
Membership type
*
Full Individual - £150
Full Individual (Student Just Graduated) - £99
Joint - £225
Junior - £75
Suspended - £0
Student/Full Time Education - £99
NTU or UON complete the Student membership form www.eastmidlandsregionalrange.org.uk/join-the-club/
Club storage of Firearms (If needed) per week.
1 item
2 items
3 items
Signature - On behalf of a junior (Under 18)
Signature
*
Please verify that you are human
*
Save
Submit
Should be Empty: